Central Oregon clinic ratings released

Patients can look up quality ratings for 20 local physician clinics and see how their primary care doctors performed on preventive health screenings and chronic care management.

The ratings, released Tuesday by the nonprofit group Oregon Health Care Quality Corporation, are based on billing data from government and private health plans. While patients can search by clinic or doctor name, at www.partnerforqualitycare.org, results are given on a clinicwide basis, and only for offices with three or more providers and at least 30 patients.

The ratings classify clinics as at, above or below the state average on 13 measures, such as how often they prescribe generic medications or order cholesterol tests.

Fall Creek Internal Medicine in Bend had the highest scores among the region’s clinics, with four of 13 measures above average and one below. Cascade Internal Medicine in Bend was the only other area clinic with multiple measures above average. Mosaic Medical, which serves a high number of low-income and uninsured patients, had worse results, with between two and four measures below average at its Bend, Madras and Prineville locations.

Mosaic clinic officials questioned whether their data was accurate, but preferred to look at the potential benefits offered by the ratings nonetheless.

“We have no idea whether it’s valid or not, but that’s far less relevant to us right now,” said Dr. Divya Sharma, medical director of complex care at Mosaic. “What’s important to us is that we continue to participate in the process of transparency. … We’re certainly going to look at where we possibly have our weaknesses as an opportunity for improvement.”

Results were generally worse in Prineville and Madras clinics than in Bend or Redmond. That might reflect the difficulty of getting rural patients into the clinic on a timely basis or financial barriers to care. Additionally, the data was not able to account for patients who might have gotten their care elsewhere.

“For a lot of these clinics, their populations also go outside for services,” said Katrina Kahl, communications director for the quality group. “So sometimes, we might not actually be picking up that they got a mammogram or they received a cervical cancer test, because they might have gone to a different clinic, like a Planned Parenthood.”

The group, also known as Q-Corp., released similar ratings in 2008, but at the time had only 41 percent of Medicare claims in Oregon in its database. The group now has access to 100 percent of claims from the Oregon Health Plan, 80 percent of private insurance claims and 92 percent of Medicare claims.

“So now we actually have quite good representation across all of the different payer types and populations,” Kahl said.

Q-Corp. was one of the first groups in the nation to get access to billing data from the federal Centers for Medicare & Medicaid Services, and the first to issue public reports based on it. Adding the Medicare data allowed the group to meet the 30-patient threshold for more quality measures at more clinics, and in particular, to report on more chronic care issues. Patients can now see how twice as many clinics performed on heart disease measures, for example, than in 2008.

Officials from the Oregon Medical Association serve on Q-Corp. committees and provided input into the process, but the group nonetheless had concerns about the accuracy of the ratings.

“Although it’s promising that CMS has expanded the amount of quality data available to consumers, we have had concerns about the accuracy of the data released in the past,” said Ken Cole, director of marketing and communications for the physicians’ group. “We understand that the vast majority of primary care physicians in Oregon have taken the time to review it, but there are still some providers who may not have had that opportunity yet.”

The OMA also questioned whether using individual measures, such as the number of tests ordered, accurately reflects the quality of care provided by physicians. Public reporting of physician quality measures has been controversial, and the evidence that it improves quality of care has been mixed.

A 2011 review by the Agency for Healthcare Research and Quality found few patients choose individual providers based on publicly reported quality measures, but that physicians do change their practice patterns when their performance is made public. Quality measures that are publicly reported, the group found, improve over time.

Medicare has been using quality data on its Hospital Compare and Nursing Home Compare websites to help consumers choose among health facilities, but has yet to publish quality data for more than a handful of physician clinics. Under its Physician Quality Reporting System, Medicare has been paying doctors bonuses for voluntarily reporting quality measures for the past two years. But starting next year, doctors will face financial penalties if they don’t report the quality data.

Eventually, that could lead to more quality data disclosed through Medicare’s Physician Compare website, which currently lists mainly administrative data for individual doctors. That could make measures like those released in Oregon commonplace.

“Providing greater transparency around quality is an important step toward empowering consumers to more actively participate in their health care,” said Dr. Jeff Absalon, chief physician officer for St. Charles Health System, in an email to The Bulletin. “While we can’t speak to the accuracy of this particular data set, we believe that information like this can prompt productive dialogue among providers and help enhance the delivery of care to patients in our region.”

Q-Corp. officials hope patients will use the measures to gauge whether they are getting the recommended screening, and if not, to raise the issue with their doctors.

“What we’re really trying to do with this site is to get people to better understand that they’re a partner in their health care, that they aren’t just a passive participant,” Kahl said. “We’re hoping that somebody with a chronic condition will say, ‘I’m supposed to be receiving these four tests every year. That’s a conversation I need to have with my doctor.’”

A Bend attorney representing the father of Edwin Mays, who died of a methamphetamine overdose in the Deschutes County jail Dec. 14, has filed a tort claim notice of intent to sue the county, a Bend Police officer, the sheriff’s office and 10 of its employees Tuesday.
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